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Case Pres > 2. Antifungals > Flashcards

2. Antifungals Flashcards

1
Q

Candida albicans has two types of morphology, what are they?

A
  1. Oral yeast buds (commensualism)

2. Hyphae (tissue invasion) - the chronic variety that does not wipe off

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2
Q

Candida albicans - three factors to increase levels

A
  1. Prosthetic appliances (88%)
  2. Smoking
  3. Females
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3
Q
  1. Two forms of acute oral candidiasis

2. Can you wipe them off?

A 
1. Acute pseudomembranous (thrush)
Acute atrophic (erythematous)
  1. Yes, you can (so oral yeast bud/commensualism form)
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4
Q

Two forms of chronic oral candidiasis

A
  1. Chronic atrophic (denture stomatitis)

2. Chronic hyperplastic (candidial leukoplakia)

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5
Q

Oral candidiasis - four most common intraoral sites

A
  1. Tongue
  2. Buccal mucosa
  3. Palate
  4. Floor of mouth
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6
Q

Oral candidiasis - Five predisposing factors

A
  1. Endo/exocrinopathies
  2. Medications/drugs (antibiotics, chemotherapy, steroids)
  3. Nutritional deficiencies
  4. Hematologic/immune disorders
  5. Local factors (radiation, poor oral hygiene)
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7
Q

Systemic dissemination of oral candidiasis in the immunocompromised patient in which two sets of organs and valve?

A
  1. Esophageal and pulmonary
  2. Kidney, heart, brain, liver, eyes
  3. Prosthetic heart valve endocarditis
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8
Q

Nystatin (mycostatin)

  • Mode of Action
  • Indications?
  • Route of admin?
  • Side effects?
A
  1. Imidazole anti fungal (ergosterol disruption), so alters cell wall permeability2. Localized anti fungal infection
  2. Tablet/pastille, oral suspension, ointment, powder
  3. Minimal side effects
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9
Q

Clotrimazole (mycelia)

  • Mode of action
  • Indications?
  • Side effects?
  • What organ function needs to be monitored due to clotrimazole’s side effects?
A
  1. Imidazole anti fungal (ergosterol disruption), so alters cell wall permeability
  2. Local infections
  3. Nausea/vomitting, elevated AST (liver enzyme), teratogenic effect in mice and rats
  4. Liver function tests
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10
Q

Ketoconazole (Nizoral)

  • Mode of Action
  • How is it different from clotrimazole and nystatin?
  • Indications?
  • Requires what to be absorbed?
A
  1. Imidazole anti fungal (ergosterol disruption), so alters cell wall permeability
  2. Systemic antifungal
  3. systemic, disseminated, chronic mucocutaneous, localized
  4. Requires gastric acidity (no antacids, PPI’s, H2 pump inhibitors)
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11
Q

Ketoconazole (Nizoral) - Drug interactions (3)

A
  1. Terfenadine, astemizole (antacids)
  2. Antacids, H2 antagonists
  3. Omeprazole, lansoprazole (PPI’s)
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12
Q

Ketoconazole (Nizoral)- Side effects (5)

A
  1. Nausea/vomiting
  2. Hepatotoxicity (monitor liver function just like clotrimazole)
  3. Anaphylaxis
  4. Disulfram reaction (don’t take with alcohol)
  5. Avoid in breast feeding mothers
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13
Q

Fluconazole (diflucan)

  • Mode of action?
  • Indications
  • Key differences (2) between fluoconazole and ketoconazole
A
  1. Interferes with P450, increasing cell wall permeability
  2. Systemic, localized
  3. Does not require gastric acidity and possibility of resistance
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14
Q

Fluconazole - Side effects (4)

A
  1. Nausea and vomiting
  2. Expensive
  3. Fungal resistance
  4. Avoid in breast feeding women
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15
Q

Fluconazole - Drug interactions 93)

A
  1. Terfenadine, cisapride
  2. Sulfonyureas (increase hypoglycemia risk)
  3. Coumadin (monitor PT/INR)
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16
Q

What is Dr. Monasky’s favorite anti-fungal to prescribe?

A

Fluconazole

  • Fluconazole doesn’t require gastric acid
  • Fluconazole doesn’t cause as much nausea as clotrimazol
17
Q

What anti-fungal is considered the last line of defense due to its strength?

A

Itraconazole (sporanox)

18
Q

Itraconazole (sporanox)

  • Mode of action?
  • Indications
  • Two special factors?
A
  1. Blocks synthesis of ergosterol (triazole anti fungal)
  2. Chronic oral candidiasis
  3. Possibility of resistance and requires gastric acidity
19
Q

Itraconazole (Sporanox) - Adverse reactions (4)

A
  1. Nausea and vomiting
  2. Hepatotoxicity
  3. Rash, Steven Johnson syndrome
  4. Avoid in breast feeding
20
Q

Itraconazole (drug interactions)

A
  1. Terfenadine, cisapride, astemizole
  2. H2 blockers/PPI’s - omeprazoule, lansoprazole
  3. Coumadin (monitor PT/INR)
21
Q

Amphotericin B (Funigzone)

  • Mode of action
  • Indications
  • Drug interactions
  • Modes of deliery
A
  1. Polyene fungal - binds to fungal cell membrane
  2. Localized (oral rinse)
  3. No significant drug interactions
  4. Oral rinse of IV formulation (only infectious disease specialists)
22
Q

CHX (Peridex)

  • Mode of action
  • Do not prescribe with what other anti-fungal?
A
  1. Detergent activity on fungal lipid membrane

2. Do not prescribe with nystatin

23
Q

Which antifungals out of this list are used localized (5) and which systemically (2)?
- Nystatin, clotrimazole, ketoconazole, fluconazole, itraconazole, amphotericin B, chlorhexidine

A

Localized: Nystatin, clotrimazole, itraconazole, amphotericin B, chlorhexidine

Systemic: Ketoconazole and fluconazole

24
Q

Which antifungals are not given to breast feeding mothers? (3)
- Nystatin, clotrimazole, ketoconazole, fluconazole, itraconazole, amphotericin B, chlorhexidine

A

Ketoconazole, fluconazole, itraconazole

25
Q

Which antifungals do you need to monitor PT/INR?

A

Fluconazole and itraconazole

26
Q

Which antifungals do you need to monitor liver function?

A

Clotrimazole and Ketoconazole

Case Pres (7 decks)

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